Tuberculosis, a disease that kills two people every three minutes in India, is growing increasingly difficult to tackle, signalling a need for a new line of drugs, says K. Narayanaswamy Balaji, associate professor at the Indian Institute of Science and one of the 11 recipients of India's top science honour, the Shanti Swarup Bhatnagar Prize for Science and Technology, this year.

Not only has the bacteria become multi-drug resistant, it is now increasingly associated with lifestyle diseases such as diabetes, says Dr. Balaji. The Bhatnagar prize cited his research on the mechanism TB bacteria uses to alter the body's immune response to its own benefit. An understanding of this pathway could lead to effective drug design, he hopes.

“The drugs we use today were developed in the 1970s. Decades have passed and new, resistant strains of the disease have developed,” Dr. Balaji told The Hindu. Much of the delay in the development of drugs comes from the prejudice, until recently, surrounding the “third-world disease”, he added.

“TB can no longer be considered a “poor man's” disease. People all over the world, and in urban areas, contract TB. A third of the world's population is currently infected with the TB bacillus.

People with diabetes, post-operative patients, pregnant women and children — anyone whose immune system is undermined — are particularly vulnerable,” he explains. What makes TB difficult to cure is the sophisticated biology it uses to dodge both drug therapies and the body's natural immune system. “One, its cell-wall is highly fortified and quite impermeable to drugs; two, the bacteria can travel from the site of infection (generally lungs) and find new hiding places in other organs such as the stomach and brain; and three, it has the ability to remain latent — for decades together — and emerge to infect the patient again.”

On the positive side, there is a growing awareness about the disease, he says.

“There is a new thrust to R&D for drug development in India and abroad, that looks at directly targeting the bug, both the active and latent ones.” But it could be several more years before these new therapies enter the market, he adds.

Dr. Balaji is one of three scientists from Bangalore to receive the Bhatnagar prize.

The other recipients are: Upadrasta Ramamurty of IISc., awarded in the engineering field, and Balasubramanian Sundaram of the Jawaharlal Nehru Centre for Advanced Scientific Research in the field of chemical sciences.